<?php defined('SYSPATH') OR die('No direct access allowed.');
	$arrVacinas = ( isset($arrVacinas) )? $arrVacinas: array();
        
        
?>
<form action="<?php echo url::site( $action ); ?>" method="post">
    <div data-role="fieldcontain" class="ui-hide-label">

        <div class="ui-field-contain ui-body ui-br" data-role="fieldcontain">
            <label class="ui-input-text" for="nome_responsavel">Nome do responsável:</label>
            <input type="text" id="nome_responsavel" name="nome_responsavel" placeholder="Nome do responsável" />
        </div>
        
        <fieldset>
            <legend>Endereço: </legend>
        
            <div data-role="fieldcontain">
                <input type="text" class="rua" name="rua" placeholder="Rua:" /> 
            </div>

            <div data-role="fieldcontain">
                <input type="text" class="numero" name="numero" placeholder="Número:" /> 
            </div>

            <div data-role="fieldcontain">
                <input type="text" class="numero" name="complemento" placeholder="Complemento:" /> 
            </div>

            <div data-role="fieldcontain">
                <input type="text" class="referencia" name="referencia" placeholder="Ponto de Referência:" /> 
            </div>
            
            <div data-role="fieldcontain">
                <input type="text" class="bairro" name="bairro" placeholder="Bairro:" /> 
            </div>
            
        </fieldset>
        
        <fieldset>
            <legend>Telefones</legend>
            <div data-role="fieldcontain">
                <input type="tel" class="tel_fixo" name="telefone[]" placeholder="Telefone Fixo:" />
            </div>

            <div data-role="fieldcontain">
                <input type="tel" class="tel_cel" name="telefone[]" placeholder="Telefone Celular:" />
            </div>
        </fieldset>
        <hr />
        <div data-role="fieldcontain" class="ui-grid-a">
            <div class="ui-block-a"><button type="submit" name="cadastrarResponsavel">Salvar</button></div>
            <div class="ui-block-b"><button type="reset">Cancelar</button></div>
        </div>
    </div>
</form>
